1043223241 NPI number — BLUEGRASS OXYGEN INC

Table of content: (NPI 1043223241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043223241 NPI number — BLUEGRASS OXYGEN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUEGRASS OXYGEN INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043223241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1032 MAJAUN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40511-1151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-277-2583
Provider Business Mailing Address Fax Number:
859-277-5454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3622 DECOURSEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41015-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-221-0202
Provider Business Practice Location Address Fax Number:
513-221-2000
Provider Enumeration Date:
08/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARNHOUT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
859-277-2583

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)